Rhinoplasty (Nose Job)

Overview

Rhinoplasty is one of the most common cosmetic procedures worldwide with 350,000 treatments annually. While being more popular among women, rhinoplasty is considered the most common plastic surgery among men.

It involves sculpting the nose by adding grafts to depressed areas, removing tissue from elevated areas, or repositioning the supporting bones, cartilage, and soft tissue.

Candidates

Medical Uses of Rhinoplasty

• Breathing issues due to nose trauma or prior surgery 
• Persistent nasal congestion due to seasonal allergy that is unresponsive to medical treatment. 
• A nasal defect since birth that alters its shape and/or function.

What Can Go Wrong?

• Excessive removal of bone or cartilage: Causes cosmetic distortion and breathing issues (or loss of sensation to air entry which gives a feeling of nasal obstruction) 
• Contour irregularity 1%  2Vila, P. M., Jeanpierre, L. M., Rizzi, C. J., Yaeger, L. H., & Chi, J. J. (2020). Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngology-- Head & Neck Surgery, 146(4), 347–354. https://doi.org/10.1001/jamaoto.2019.4787
• Graft displacement: due to inability to securely anchor it. 
• Perforation of Nasal Septum: treated with nasal spray if small or surgery if large or causing obstruction/bleeding.

Benefits

• Satisfaction: 83%-89% are satisfied with their surgical outcomes. 3Arima, L. M., Velasco, L. C., & Tiago, R. S. L. (2011). Crooked nose: Outcome evaluations in rhinoplasty. Brazilian Journal of Otorhinolaryngology, 77(4), 510–515. https://doi.org/10.1590/s1808-86942011000400016 4Khansa, I., Khansa, L., & Pearson, G. D. (2016). Patient Satisfaction After Rhinoplasty: A Social Media Analysis. Aesthetic Surgery Journal, 36(1), NP1–NP5. https://doi.org/10.1093/asj/sjv095
• Psychological well-being: Boosts self-esteem and social confidence. 
• Improved breathing 

Procedure Types

Rhinoplasty is not a one-fits-all surgery, but follows a personalized approach based on your skin thickness, cartilage strength, and bony structures.

Open Rhinoplasty

• 2-3 hours

Incision site is on the outer skin

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Best for :

• Complex cases 
• When extra tissue grafts are required 
• Black people due to their thick skin 

Closed Rhinoplasty

• 1.5-2 hours

Incision site is inside the nose

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Best for:

• Minor cases (minor tip modification) 
• Revisional rhinoplasty 

Combination Therapy

Rhinoplasty can be combined with other cosmetic procedures to achieve more natural results and improve facial balance. These include chin augmentation, facelift, lip lift, and eyelid surgery. It can also be performed along with other nasal surgeries such as septoplasty. 

Risks

Rhinoplasty is generally considered a safe procedure with only rare and temporary complications. 

Adverse Reactions 

• Reduced Smell Sensation (87%) temporary and resolves on its own within 2-6 months. 5Chen, Q., Li, P., Zhao, Q., Tu, T., Lu, H., & Zhang, W. (2023). Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries. Frontiers in Neurology, 14, 1258759. https://doi.org/10.3389/fneur.2023.1258759
• Resorption 2%  2Vila, P. M., Jeanpierre, L. M., Rizzi, C. J., Yaeger, L. H., & Chi, J. J. (2020). Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngology-- Head & Neck Surgery, 146(4), 347–354. https://doi.org/10.1001/jamaoto.2019.4787
• Infection (1-2%)  6Luan, C.-W., Chen, M.-Y., Yan, A. Z.-A., Tsai, Y.-T., Hsieh, M.-C., Yang, H.-Y., & Chou, H.-H. (2022). Complications associated with irradiated homologous costal cartilage use in rhinoplasty: A systematic review and meta-analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 75(7), 2359–2367. https://doi.org/10.1016/j.bjps.2022.02.026 2Vila, P. M., Jeanpierre, L. M., Rizzi, C. J., Yaeger, L. H., & Chi, J. J. (2020). Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Otolaryngology-- Head & Neck Surgery, 146(4), 347–354. https://doi.org/10.1001/jamaoto.2019.4787
• Bleeding (less than 1%)  7Layliev, J., Gupta, V., Kaoutzanis, C., Ganesh Kumar, N., Winocour, J., Grotting, J. C., & Higdon, K. K. (2017). Incidence and Preoperative Risk Factors for Major Complications in Aesthetic Rhinoplasty: Analysis of 4978 Patients. Aesthetic Surgery Journal, 37(7), 757–767. https://doi.org/10.1093/asj/sjx023
• Breathing issues

Specific Considerations based on Ethnicity

African/African American

Unique Features: Thick oily skin, broad nose  8Momoh, A. O., Hatef, D. A., Griffin, A., & Brissett, A. E. (2009). Rhinoplasty: The african american patient. Seminars in Plastic Surgery, 23(3), 223–231. https://doi.org/10.1055/s-0029-1224802

Typical Aesthetic Goal and Surgical Plan: Sharpen tip and narrowing nostrils (done with caution to preserve the ethnic identity).

Southeast Asia

Unique Features: Small nasal height with wide base, thin septal cartilage, small bones, short nasal tip.  9Ishii, C. H. (2014). Current update in asian rhinoplasty. Plastic and Reconstructive Surgery. Global Open, 2(4), e133. https://doi.org/10.1097/GOX.0000000000000081

Typical Aesthetic Goal and Surgical Plan: Nasal bridge augmentation, sharpen tip, preserve minor depression above the tip.

South Asian (India and Pakistan)

Unique Features: Thick skin, wide nose, nasal hump.  10Bhat, U., & Patel, B. (2008). Primary rhinoplasty: An Indian perspective. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India, 41(Suppl), S9–S19.

Typical Aesthetic Goal and Surgical Plan: Narrow bony width, sharpen tip, maintain nasal height.

Middle Eastern

Unique Features: Thick skin, depressed tip, high hump. 11Rohrich, R. J., & Mohan, R. (2018). Middle Eastern Rhinoplasty: Update. Plastic and Reconstructive Surgery. Global Open, 6(12), e1984. https://doi.org/10.1097/GOX.0000000000001984

Typical Aesthetic Goal and Surgical Plan: Straighten nasal bridge, slightly lifting nasal tip.

Hispanic

Unique Features: Average nasal height, thick oily skin, rounded, wide tip, and wide nasal opening. 12Higuera, S., Hatef, D. A., & Stal, S. (2009). Rhinoplasty in the Hispanic patient. Seminars in Plastic Surgery, 23(3), 207–214. https://doi.org/10.1055/s-0029-1224800

Typical Aesthetic Goal and Surgical Plan: Sharpen tip and narrow base